Patient Info Form

If you are scheduled for an appointment in our office, print and complete this form and bring it with you. Please be thorough, as this information is used by the doctor to manage your care, and by the bookkeeper to bill your insurance(s) appropriately and minimize any out of pocket expense.

Are there any alternatives for correcting vision besides refractive surgery? What if we could non-surgically change corneal shape in a controlled manner while the patient sleeps, resulting in excellent visual acuity during waking hours without the use of glasses or daytime contact lenses? We can!

Thank you for your 15 years of fabulous service to my family and me! I love seeing all of you…Pam, Dr. R, Dr. L., Fred, etc. etc. (wonderful staff). You’re like family. Thanks again for your kindness!

- Paty G.

I have 4 children and have been a patient of Dr. Rembleski for 7 years. I am extremely happy and completely trust Dr. Rembleski with the care of our family’s vision. Dr. Rembleski is interactive and patient making the kids …

- Kristen S.

Several years ago, I was having great difficulty with my vision and subsequently met Dr. Buffington. I was diagnosed with astigmatism which has since progressed to Keratoconus. From my first visit and every visit since, Dr. Buffington’s commitment to excellence …

- Jeff H.

My family and I have been with this office for over 25 years. My right eye has a growth which makes wearing contacts very challenging. Drs. Rembleski and Buffington were able to create custom lenses in the smallest diameter possible …

- Vicki P.

I have worn glasses for years, but as my vision got worse in graduate school, I found I was no longer able to play active sports–like basketball, softball, or even running–without corrected vision. Before I came to this office I …

- Rich M.

I’d been wearing contact lenses for twenty years when I started coming to River City Doctors of Optometry. I had always worn soft lenses, so I was a bit apprehensive when Dr. Rembleski advised a switch to rigid gas permeable …